10080047 CITY OF CUPERTINO BUILDING PERMIT
ILDING ADDRESS: 10690 HALE PL CONTRACTOR:CUPERTINO PLUMBING PERMIT NO: 10080047
1300 DELL AVE STE C DATE ISSUED:08/05/2010
VNER'S NAME: RAY CRUMP PHONE NO:(408)253-0618
IER'S PHONE: 4087490321
CAMPBELL,CA 95008
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r
,ense Class- CL Lic.# (,e2y 90: MECH r RESIDENTIAL COMMERCIAL
P1 Ll Date ��
ontractor �_ JOB DES.�RIPTION:COPPER REPIPE,WATER MAIN,WATER HEATER
►ereby affirm thatI am licensed under the provisions of Chapter 9
ommencing with Section 7000)of Division 3 of the Business&Professions
ode and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
:lave and will maintain a certificate of consent to self-insure for Worker's
ompensation,as provided for by Section 3700 of the Labor Code,for the Valuation:$4300
-rformance of the work for which this permit is issued. Sq.Ft Flo(r Area:
have and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32640014.00 Occupancy Type:
ermit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
orrect.I agree to comply with all city and county ordinances and state laws relating PEf MIT EXPIRES IF WORK IS NOT STARTED
D building construction,and hereby authorize representatives of this city to enter
ipon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
ndemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAY ROM LAST CALLED INSPECTION.
:osts,and expenses which may accrue against said City in consequence of the
;ranting of this permit. Additionally,the applicant understands and will comply —1 Date:
with all pQn-point source regu-JaE.p the Cupertino Municipal Code,Section Issued by:
Signature Date
RE-ROOFS:
OWNER BUILDER DECLARATION All roofs;hall be inspected prior to any roofing material being installed.If a roof is
installed vithout first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspectio I.
the following two reasons: Date:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
I have r gad the hazardous materials requirements under Chapter 6.95 of the
declarations:
I have and will in a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
comliance
ealth
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety ode,Sect on 25532(x)should Ith the Cupertino nCode,al Chapter
toe orhandleha ardou material. &
(
performance of the work for which this permit is issued. Additio nally,should I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance,as provided for by contam mants as defined by the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
1 certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's or suthefized Date: C7
Compensation laws of California. If,after making this certificate of exemption,I —�
become subject to the Worker's Compensation provisions of the Labor Code,I must 1:%_
GCONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked.
I hereb i affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lende•'s Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of thist enter Lende-'s Address
upon the above mentioned property for inspection purposes.(We)agreeto ARCHITECT'S DECLARATION
i-'--unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said n consequence of the
ing of this permit.Additionally,the ap erstands and will comply I unde stand my plans shall be used as public records.
with all non-point source regulations. £amu Municipal Code,Section
9.18. " ' Licen;ed Professional
Signature
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
6 ITEMS OF 11 COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32640014 . )0
DATE ISSUED. . . . . . . : 08/05/2010
RECEIPT #. . . . . . . . . BS000011103
REFERENCE ID # 10080047
SITE ADDRESS . . . . . : 10690 HALE PL
SUBDIVISION . . . . . . .
CITY CUPERTINC
IMPACT AREA . . . . . .
OWNER RAY CRUMP
ADDRESS . 10690 HALE PL
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM • • " : FRANK RA DIAL '•(�A
RDIA
CONTRACTOR . . . . . . 'RANK L LIC # 612
COMPANY CUPERTINO PLUMBING
ADDRESS 1300 DEL:j AVE STE C
CITY/STATE/ZIP . . . C 08$253 /0618 95008
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL-
____ ----------
0 .00
1BCBSC VALUATION 4, 300 . 00 1 . 00 0 .00 1.00 0 .00
1BPFIXTURE NO OF FIXTURE 8 .00 64 .00 0 .00 64 . 00
42 . 00 0 .00
1PPERMITFE FLAT RATE 1 . 00 42 .00 0 .00
1PRREPIPE NO OF FIXTURE 1 .00 11 . 00 0 .00 11. 00 0 .00
1. 00 200 0.00 25. 00 0 .00
.
1PRWHEATR UNITS 42 .00 0 .00
1TRAVDOC FLAT RATE 1 . 00 4 . 00 0 .00
TOTAL PERMIT �
18 .00 0 . 00 185. 00 0 .00
_
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
--
CREDIT CARD 345 .00 VISIT
-------- ------
TOTAL RECEIPT 345 . 00
VOICE ID
DESCRIPTION '7OICE ID DESCRIPTION
___
507 FINAL PLUMBING
-- ------
301 ROUGH PLUMBING
CITY OF CUPERTINO
' REPIPE/SEWERIMMN SERVICE
CUPEI�TIN CITY of O PERMIT APPLICATION FORM
Date: �. _ 0
Build* Address: G i PZ '
CC. Phone#: ? �
O Namp.
Phone#: �S'3� 0446
Contract o ' P�ww Fax#:
Phone#: 0 1'-3 V//
Contact.
Fax#:
Contractor License#:
Cu ertino Business License#:
Job Description:
��(' / ('Jv
Commercial ❑
Residential !
Valuation:
Project Size: Express
Standard Large Mz jor
Building: Please complete
& attach it to the
relevant portion of the Green Building Che
Green g
application or if applicable, include in plan set & the sheet index.
Green Building Points:
Fee Description Fee Permit Type
Quantity Fee ID Grou
1PCSEWER Commercial building
P 1CPSS
sewer/sanitary sewer1CPRP
Commercial re-pipe p.
,-r:r fixture u' P
1PGASCOM
Commercial Gas Piping System P
1-4 Outlets ALL PERMIT
Cal Bldg Standards C ommission.. B
1BCB5C TYPES
Fee P
1BSEISMICOM Seismic Commercial
Revised 01/07/09
CITY OF CUPER.TINO
FEE ESTIMATOR-BUILDING DIVISION
FMADDRESS: DATE: REVIEWED BY:
TABP#: `VALUATION: $4,300
PERMIT TYPE: Plumbing Permit PLAN CHECk.TYPE: Alteration /Addition/ Repair
APPLICATION
PRIMARY l() !1. 1 RPRP
USE: SFD or Duplex ,.,!,«i,, l;,i.,;
!TYPE:
I' T
xw
xa
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
Re-Pipe Interior 1PRREPIPE 1 $11
Fixture or Trap 1BPFIXTURE 8 $64
Water Heater 1BPWHEAT 1 $25
' $100.00
TOTALS:
k„ c Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
Other Plumb lnsp. 1 0.0hrs $42.00 i ihc, Imp.
NOTE: Thesefees are based on the preliminary in ormation available vnd are only an estimate. Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 09-051 F.(L 7:'/;09) FEE q-Y/FEE MISC ITEMS
PME Plan Check: $0.00
�1,p pl. l 7sp .1 cry
PME Unit Fee: $100.00
PME Permit Fee: $42.00
('i I/ ,'i'ti 'f
Work Without Permit? Q Yes (E) No $0.00
Travel Documentation Fee: ITRA vDoC $42.00
Select an Administrative Item
Bld�4 Stds Commission Fee: IBCBSC $1.00
:SUBTOTALS: $185.00 $0.00 ;TOTAL FEET $185.00
Y k'
Revised: 7/28/2010
"door r Quality and Finishes
1 IAQ/Het 1th pts y--yes
2.Use Low VOC,Water-Based Wood Finishes 21AQ/He�dth pts y--yea 0
31AQ/He;dth pts y--yes
4.Use Salvaged Materials for Interior Finishes 3 Resourr:e pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/He Oth pts y=yes 0
6.Use Exterior Grade PlywoWbr Interior Uses 1 IAQ/He dth pts y--yes 0
- 4 IAO/He dth. pts y--yes; 0
S.Use FSC Certified Materials for Interior Finish 4 Resour;e pts y--yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 ReSDur:e pts y--yes; 0
10.Install Whole House Vacuum System 3 IAQ/Hc.alth pts y--yes t-- 0
N.Flooring
1.Select FSC Certified Wood Flooring_- 6 Resoures pts Y--yes 0
p.the• f.me '.blefJocmi+g# eria>Is 4 ResDurce pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resourc: pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl .5 IAQ/He filth pts y--yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y--yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts yeses 0
Total Points Available: �— 1401 1301 57
Total Points Project Receive 01 0 0
�L
G:datalprogslgreenbu 1c11nggu definesfremodelerslgresnpointsfina1212D4proteDredxls
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: r 0(0 110 Cc PZ-, PERMIT#
OWNER'S NAME: C. C/'uM PHONE# 3 �t
GENERAL CONTRACTOR: BUSINESS LICENSE 2 Y F05-
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTO RVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. j0
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date